Telecytology in Hokkaido Island, Japan: results of primary telecytodiagnosis of routine cases

Abstract

In 1997, an Internet-based static image telepathology system was built at Sapporo National Hospital, Japan. We can exchange high-resolution microscopical images through a file transfer protocol server and discuss cytological findings and diagnosis on an electronic mailing list. We applied the system to primary telecytodiagnosis. From May 1997 to April 1999 we have made diagnoses of 614 daily cases only by looking at the video monitor images transmitted from the cytotechnologist of Wakkanai Municipal Hospital 300 km distant from Sapporo. The concordance between telecytodiagnosis and glass slide diagnosis was 88.6%. Kappa statistics for cervical smears was 0.919 and that for specimens other than uterine cervix was 0.810. The accuracy of telecytodiagnosis was 91.4%, and was not substantially different from that of the conventional mail-based cytology in a previous year. We had five cases with a severely inappropriate diagnosis in telecytology, all of which however were quickly corrected by follow-up histological or cytological specimens. With the use of an electronic mailing list the participants had quick and sufficient discussions. We conclude that telecytology is very useful for primary cytodiagnosis in regional medicine and that it may raise the accuracy of cytodiagnosis in future, if we make consistent efforts to reflect the benefits of telecytology in daily practices. This is the first report of clinical results of telecytology from Japan.

Making Cytological Diagnoses on Digital Images Using the iPath Network

“…The diagnostic difficulties and the high interobserver variability in urinary cytology have already been well perceived in previous studies [13,18,39]. Our previous online quiz with 246 participants showed that only 34% of the low-grade and 76% of the high-grade urothelial neoplastic lesions (G3) were concordantly assessed by the participants and that the rate of false diagnoses was also relatively high, even among experienced cytologists [18].…”

“…The latter studies have focused on cervical smears [7,8,9,10,11] or on both gynecological and nongynecological [2] as well as mixed nongynecological cytology [12,13], whereas few have focused on fine-needle aspirations (FNAs) from a single organ like the pancreas [14], thyroid gland [15,16], liver [17] or urinary tract [18]. Most of these studies on telehistology as well as on telecytology report a concordance rate of 80-90% between the diagnoses made on digital images and the reference diagnoses made on the regular glass slides.…”

Digital Cytology: Current State of the Art and Prospects for the Future

“…These cases were all difficult differential diagnoses, including lymphoma, bile duct and salivary gland neoplasia, in which routine glass slide diagnosis might be fraught with difficulty. The authors conclude that this system worked adequately for routine use [33]. Other examples of static-image cytology have shown excellent accuracy and reproducibility among observers in a variety of organ systems and even for use in veterinary cytology practice [34,35,36,37].…”

“…For a variety of aspiration specimens, Jialdasani et al [32] reported a ‘clinically useful’ diagnosis in 91% of cases using static-image telecytology. Yamashiro et al [33] report on their introduction of a static image-based telecytology system for primary diagnosis in Japan. Over a 2-year period, 614 routine cases were transmitted by cytotechnologists to pathologists working 300 km away, with case discussion simultaneously via e-mail.…”

Telepathology in Cytopathology: Challenges and Opportunities

“…A variety of institutions and practices have described their experience with telepathology in the cytopathology laboratory [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. The aim of this article is to discuss the concepts and goals of telepathology, review the infrastructure necessary for implementation, and cover the necessary validation and regulatory requirements.…”